title: Proposed score for survival of patients with myelodysplastic syndromes.
abstract: BACKGROUND
  Patient selection for various therapies in myelodysplastic syndromes (MDS) is based on prognostic factors, scoring systems and the individual life expectancy. However, most established risk scores include mainly disease-related parameters and thus focus on leukaemia-transformation rather than survival.
  
  
  METHODS
  To establish a risk score optimized for prediction of survival, we analysed international prognostic scoring system (IPSS)-related and IPSS-independent variables in 400 patients with primary MDS (median age: 71 years; range 18-91) of the Austrian MDS platform. Patients were randomly split into a learning sample (60%) and validation sample (40%). External validation was performed on 93 patients from the Heinrich Heine University (Duesseldorf/Germany).
  
  
  RESULTS
  By multivariate analysis, IPSS, ferritin, age and comorbidities were found to be independent predictive variables concerning survival. Based on weighing these prognostic parameters against each other, we established a novel survival score employing IPSS, ferritin (< 900 ng/mL = 0; ≥ 900 ng/mL = 1), age (< 70 years = 0; 70-79 years = 1; ≥ 80 years = 1.5) and HCT-CI comorbidity (low/intermediate = 0; high = 0.5). Using this score, four prognostic risk groups could be discriminated in the validation sample, with highly significant differences in life expectancy [median survival: LowS (score 0), not reached; Int-1S (score 0.5-1.0), 3.84 years; Int-2S (score 1.5-2.0): 2.72 years; and HighS (score > 2.0): 0.80 years; P < 0.0001].
  
  
  CONCLUSIONS
  Our newly proposed score may be a useful tool for survival prediction in MDS and helpful in patient selection for various therapies in daily practice and clinical trials.
authors.affiliation: Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.forename: Michael
authors.initials: M
authors.lastname: Kundi
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wimazal
authors.forename: Thomas
authors.initials: T
authors.lastname: Nösslinger
authors.forename: Anabel
authors.initials: A
authors.lastname: Schönmetzler-Makrai
authors.forename: Reinhard
authors.initials: R
authors.lastname: Stauder
authors.forename: Otto
authors.initials: O
authors.lastname: Krieger
authors.forename: Judith
authors.initials: J
authors.lastname: Neukirchen
authors.forename: Ulrich
authors.initials: U
authors.lastname: Germing
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeilstöcker
authors.forename: Peter
authors.initials: P
authors.lastname: Valent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality*; D018579:Patient Selection; D011379:Prognosis; D055815:Young Adult
keywords: Age; comorbidity; ferritin; international prognostic scoring system; myelodysplastic syndromes; survival